| NPI | 1053635201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14606) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00623500) |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2016-03-31 |